Esophagojejunal Anastomosis by Circular Stapler in Pediatric Patients: Size Minima Defined by Experience and Geometry. J Laparoendosc Adv Surg Tech A 2019 Oct;29(10):1311-1314
Date
09/25/2019Pubmed ID
31549898DOI
10.1089/lap.2019.0092Scopus ID
2-s2.0-85073490967 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
Background: Esophagojejunostomy is facilitated by use of a circular stapler, particularly when performed laparoscopically. The minimum patient size that will allow use of circular staplers in the small intestine is unknown. Materials and Methods: Retrospective review of esophagogastric dissociations performed at a single tertiary care institution for 48 months. This was combined with a geometric derivation of a size-estimation formula. Results: From the 7 cases identified, patients weighing >16 kg easily accommodated the 21 mm stapler. There was a narrow fit in the patient weighing 13.6 kg, and the 6 kg patient was too small for the stapler. Conclusions: Through a combination of clinical observation and physical reasoning, circular stapler applicability in small intestine is predicted by patient weight or intestinal measurement. Patients weighing >16 kg will accept the stapler, whereas patients <13 kg are likely too small. Alternately, on the basis of a geometric derivation, if the width of the flat intestine is >1.6 × the device diameter, the device will fit. This calculation can be applied broadly (e.g., incision length for laparoscopic ports or single-port access devices).
Author List
Jamshidi R, Densmore JC, Gourlay DM, Lal DR, Calkins CMAuthors
Casey Matthew Calkins MD Professor in the Surgery department at Medical College of WisconsinJohn C. Densmore MD Professor in the Surgery department at Medical College of Wisconsin
David M. Gourlay MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAnastomosis, Surgical
Child
Child, Preschool
Esophagus
Female
Gastrectomy
Humans
Jejunum
Male
Retrospective Studies
Stomach Neoplasms
Surgical Staplers
Young Adult
